A total of 398,237 lactations of Danish Holstein dairy cows were studied with the main objective to investigate the effects of metritis on 2 fertility variables: interval from calving to first insemination (CFI) and nonreturn rate at 56d after first insemination (NR56), adjusting for milk production and body condition score as confounders. Metritis was defined as a score of at least 5 (indicating purulent vaginal discharge with abnormal smell) on the Danish uterine score scale (from 0 to 9, used to evaluate vaginal discharge in the first 19d postpartum on all fresh cows in herds participating in a national herd health program). Cows with metritis in early lactation presented a significant delay in first insemination (hazard ratio of 0.80) and a significantly reduced probability of success at first insemination. The effect of metritis was also present after adjusting for possible effects of body condition score, milk production in the first month of lactation, parity, herd, and year-season. Only a small part of the observed effect of metritis could be explained by variation in body condition score at calving and milk production in the first month after calving. The results from this large-scale study underscore the deleterious effects of metritis on the fertility variables CFI and NR56.